TY - JOUR
T1 - Outcomes of Patients with Stress-Induced Cardiomyopathy Diagnosed by Echocardiography in a Tertiary Referral Hospital
AU - Lee, Pil Hyung
AU - Song, Jae Kwan
AU - Sun, Byung Joo
AU - Choi, Hyung Oh
AU - Seo, Jeong Sook
AU - Na, Jin Oh
AU - Kim, Dae Hee
AU - Song, Jong Min
AU - Kang, Duk Hyun
AU - Kim, Jae Joong
AU - Park, Seong Wook
PY - 2010/7
Y1 - 2010/7
N2 - Background: Because stress-induced cardiomyopathy (SIC) is increasingly being observed during routine daily practice, we sought to explore the clinical features and factors that determine the outcome of SIC in a tertiary referral hospital. Methods: Patients with typical left ventricular (LV) takotsubo (apical ballooning) or inverted takotsubo on 2-dimensional echocardiography were prospectively enrolled, and their clinical data were analyzed. Results: Over a 63-month period, 56 consecutive patients (median age and interquartile range = 64 years [52-74 years]) were identified. Women comprised 79% (44/56) of all patients. The triggering events were acute medical illness, including sepsis and hypoxemia in 29 patients (52%, group A), in-hospital surgery/procedure in 17 patients (30%, group B), and emotional stress in 10 patients (18%, group C). Chest pain was more frequently observed in group C (50%) than in groups A (14%) and B (6%) (P = .021), whereas dyspnea was the presenting symptom in groups A and B. Typical takotsubo and inverted takotsubo were observed in 48 and 8 patients, with a median ejection fraction of 33%. Other abnormalities included dynamic LV outflow tract obstruction (n = 2), LV thrombus (n = 2), and right ventricular dysfunction (n = 12). Nine deaths (16%) occurred during hospitalization. The groups did not differ in mortality. The Acute Physiology and Chronic Health Evaluation II score (odds ratio 1.405; 95% confidence interval, 1.091-1.810; P = .009) and absence of LV function recovery within 1 week (ejection fraction < 50%) (odds ratio 14.080; 95% confidence interval, 1.184-167.475; P = .036) were independent factors associated with mortality. During clinical follow-up up to 6 months, 3 more patients died, 2 of whom had recurrences of SIC. Conclusions: SIC in a tertiary referral hospital was mainly associated with physical stressors and characterized by diverse clinical presentations, high mortality, and occasional fatal recurrences.
AB - Background: Because stress-induced cardiomyopathy (SIC) is increasingly being observed during routine daily practice, we sought to explore the clinical features and factors that determine the outcome of SIC in a tertiary referral hospital. Methods: Patients with typical left ventricular (LV) takotsubo (apical ballooning) or inverted takotsubo on 2-dimensional echocardiography were prospectively enrolled, and their clinical data were analyzed. Results: Over a 63-month period, 56 consecutive patients (median age and interquartile range = 64 years [52-74 years]) were identified. Women comprised 79% (44/56) of all patients. The triggering events were acute medical illness, including sepsis and hypoxemia in 29 patients (52%, group A), in-hospital surgery/procedure in 17 patients (30%, group B), and emotional stress in 10 patients (18%, group C). Chest pain was more frequently observed in group C (50%) than in groups A (14%) and B (6%) (P = .021), whereas dyspnea was the presenting symptom in groups A and B. Typical takotsubo and inverted takotsubo were observed in 48 and 8 patients, with a median ejection fraction of 33%. Other abnormalities included dynamic LV outflow tract obstruction (n = 2), LV thrombus (n = 2), and right ventricular dysfunction (n = 12). Nine deaths (16%) occurred during hospitalization. The groups did not differ in mortality. The Acute Physiology and Chronic Health Evaluation II score (odds ratio 1.405; 95% confidence interval, 1.091-1.810; P = .009) and absence of LV function recovery within 1 week (ejection fraction < 50%) (odds ratio 14.080; 95% confidence interval, 1.184-167.475; P = .036) were independent factors associated with mortality. During clinical follow-up up to 6 months, 3 more patients died, 2 of whom had recurrences of SIC. Conclusions: SIC in a tertiary referral hospital was mainly associated with physical stressors and characterized by diverse clinical presentations, high mortality, and occasional fatal recurrences.
KW - Echocardiography
KW - Outcome
KW - Stress
KW - Takotsubo cardiomyopathy
UR - http://www.scopus.com/inward/record.url?scp=77953657006&partnerID=8YFLogxK
U2 - 10.1016/j.echo.2010.05.002
DO - 10.1016/j.echo.2010.05.002
M3 - Article
C2 - 20620862
AN - SCOPUS:77953657006
SN - 0894-7317
VL - 23
SP - 766
EP - 771
JO - Journal of the American Society of Echocardiography
JF - Journal of the American Society of Echocardiography
IS - 7
ER -